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DPT 616 : MSK > Pathophysiology of the Hand and Wrist > Flashcards

Pathophysiology of the Hand and Wrist Flashcards

1
Q

the intrinsic extensors at the hand/wrist primarily extend at what joint?

A

MCP

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2
Q

trigger fingers tend to occur at what pulley?

A

A1 pulleys

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3
Q

what is a Boutonniere’s deformity?

A

central slip dysfxn at the middle phalanx

triangular ligament attenuation

volar migration of the lateral bands

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4
Q

Boutonniere’s deformity is ____ of the MCP, ____ of the PIP, and ____ of the DIP

A

extension, flexion, extension

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5
Q

what are some interventions for Boutoniere’s deformity?

A

surgical repair

splinting to keep the PIP in a more extended position

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6
Q

t/f: Boutonniere’s deformity causes friction over the radial styloid

A

true

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7
Q

what is the etiology of a Swan neck deformity?

A

disruption of the volar pulley at the PIP

flexor tendon rupture at the PIP and extensor tendon at the DIP

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8
Q

Swan neck deformity is ____ of the PIP and ____ of the DIP

A

extension, flexion

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9
Q

t/f:there are deficits in active PIP flexion with a Swan neck deformity

A

true

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10
Q

what are some interventions for Swan neck deformity?

A

surgical repair

splinting to facilitate PIP flexion

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11
Q

what is the etiology of DeQuervain’s tenosynovitis?

A

tenosynovitis of the APL and EPB due to CTD (cumulative trauma disorder ie overuse)

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12
Q

what are the s/s of DeQuervain’s tenosynovitis?

A

pain at the base of the thumb

pain at the radial styloid

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13
Q

what are some interventions for DeQuervain’s tenosynovitis?

A

reduce edema

splinting

NSAIDs

stretch/ROM

surgical release

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14
Q

t/f: DeQuervain’s tenosynovitis causes friction over the radial styloid

A

true

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15
Q

t/f: resistance will usually cause pain in DeQuervain’s tenosynovitis

A

true

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16
Q

if there is a (-) Finkelstein test and pain in the snuff box, what may be going on?

A

fx

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17
Q

if DeQuervain’s tenosynovitis is chronic is it easier or harder to treat?

A

harder to treat

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18
Q

t/f: steroid injection are a common treatment for DeQuervain’s tenosynovitis

A

false, steroid injection may cause breakdown of the tendons, putting them at risk for rupture

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19
Q

what is the test most commonly used for DeQuervain’s tenosynovitis?

A

Finkelstein test

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20
Q

how many tendons cross the wrist?

A

12

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21
Q

where does the FCR insert?

A

on the 2nd and 3rd metacarpals

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22
Q

where does the FDS insert?

A

on the base of the middle phalanx

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23
Q

where does the FDP insert?

A

on the base of the distal phalanx

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24
Q

what motion does the FDS produce?

A

PIP flexion

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25
Q

t/f: the FDP is 50% stronger than the FDS

A

true

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26
Q

what are the 2 bundles of the FDP?

A

one bundle from the radius to the index finger

another bundle from the ulna to the long, ring, and pinky fingers

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27
Q

what is the Quadriga effect?

A

the distal tendon of 1 finger limits the active motion of other tendons bc of their shared muscles belly

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28
Q

t/f: the excursion of combined tendons is equal to the shortest tendon’s excursion

A

true

29
Q

how long does it take to regain tensile strength of tendons?

A

12 weeks to a year

30
Q

adhesions tend to form where?

A

in zones 1 and 2 (distal hand in the fingers)

31
Q

t/f: PROM helps eliminate adhesions

A

false, ACTIVE flexion is required to move the tendons through the proximal pulley (A1 pulleys)

32
Q

what are the primary intervention strategies for management of flexor tendon ruptures and repairs?

A

edema control

scar management

passive finger flexion

active finger extension

33
Q

t/f: full IP extension must be attained immediately post-op flexor tendon repair/rupture but extension at the MCP, PIP, and DIP places adverse stretch

A

true

34
Q

t/f: passive finger extension is avoided in early stages of flexor tendon ruptures/repairs bc of tension it puts on the tendons

A

true

35
Q

what does a dorsal blocking splint for post flexor tendon repair?

A

allows MCP flexion w/full IP extension

36
Q

t/f: full wrist and finger extension is not allowed until later stages of flexor tendon repair/rupture

A

true

37
Q

active finger flexion is started at ___ weeks post flexor tendon repair if 40-50 deg difference bw PROM and AROM

A

4

38
Q

t/f: the MCP may be splinted in slight flexion (15-20 deg) to maintain the length of the collateral ligs

A

true

39
Q

what is a trigger finger?

A

thickening of the flexor tendon sheath or tendon typically at the A1 pulleys causing “snapping” as the nodule pulls through the pulley

40
Q

what is the MOI of trigger finger?

A

insidious or due to repetitive gripping of sharp edges

41
Q

t/f: there is a palpable nodule on the flexor tendon with a trigger finger

A

true

42
Q

what are the intervention strategies for trigger finger?

A

rest

hand-based splint with MCP jt at 0 deg that allows full PIP motion

injections

surgery followed by progression to light strengthening

43
Q

t/f: there is strong evidence for modalities to treat trigger finger

A

false, there is weak evidence

44
Q

what structures run through the carpal tunnel?

A

median nerve a 9 tendons

45
Q

what tendons run through the carpal tunnel?

A

FPL

4 FDS tendons

4 FDP tendons

46
Q

why is the median nerve at risk in the CT?

A

bc it is the weakest structure, so it tends to get compressed

47
Q

what are the tests for CTS (carpal tunnel syndrome)?

A

Tinel

Phalen/reverse

CT compression

48
Q

how can we manage CTS?

A

activity modification

wrist mobs

tendon glides

neuromobilization (median nerve glides)

splinting to hold the hand in just a couple deg of ext (15-20)

bike fitting

modalities

surgery

49
Q

what activity modification can be given for CTS?

A

neutral wrist in typing on the computer

50
Q

where is the Tunnel of Guyon?

A

on the ulnar side of the wrist

51
Q

what nerve is effected in the tunnel of Guyon?

A

the ulnar nerve

52
Q

what are the tests for TFCC pathology?

A

TFCC load test

TFCC stress test

gripping rotatory impaction test (GRIT)

53
Q

with a (+) GRIT, would pronation or supination be stronger?

A

supination would be stronger for a (+) GRIT

54
Q

what are ways to manage TFCC syndrome?

A

reduce pain and swelling

restore movt

RESTORE/REHAB STRENGTH AND FXN

surgical repair/debridement

55
Q

what is the MOI of TFCC syndrome?

A

axial loading with compression through the wrist

forceful twist

56
Q

t/f: TFCC syndrome involves wearing of the central portion

A

true

57
Q

t/f: TFCC syndrome is often a chronic condition

A

true

58
Q

disc perforations are present in what % of those over 50 with TFCC syndrome?

A

50-60%

59
Q

a colles fx is ___ angulation

A

dorsal

60
Q

collies fx is usually due to what MOI?

A

FOOSH injury

61
Q

t/f: a colles fx leads to ROM limitations that we may or may not be able to fully regain

A

true

62
Q

what are the tests we learned for jt and bone conditions of the wrist and hand?

A

Watson scaphoid instability test

axial loading test

63
Q

other than scaphoid fx, what else could the axial loading test tell us about?

A

CMC or MCP arthritis

64
Q

is game keeper’s thumb chronic or acute?

A

chronic

65
Q

is skiers thumb chronic or acute?

A

acute

66
Q

how is gamer keeper’s thumb/skier’s thumb managed?

A

thumb spica splint

modalities to control pain and inflammation

ROM to tolerance

eventually strengthening

67
Q

what is a game keeper’s thumb/skier’s thumb?

A

tear of the UCL of the 1st MCP

68
Q

what is a Boxer’s fx?

A

fx of the 5th metacarpal

69
Q

what is the test for lunate dislocation?

A

Murphy’s sign

DPT 616 : MSK (23 decks)

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